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John H Kempen, Mark L Van Natta, Michael M Altaweel, James P Dunn, Douglas A Jabs, Susan Lightman, Jennifer E Thorne, Janet T Holbrook, The Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group; Visual acuity outcome of non-infectious intermediate, posterior, and panuveitis in the Multicenter Uveitis Steroid Treatment (MUST) Trial. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6036.
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To identify factors predicting 2-year best-corrected visual acuity (BCVA) outcome of non-infectious intermediate, posterior, and panuveitis.
In the Multicenter Uveitis Steroid Treatment (MUST) Trial, subjects with active or recently active (within 60 days) intermediate (+/- anterior), posterior or panuveitis for which systemic corticosteroid therapy was indicated were randomized to treatment with standardized systemic therapy or fluocinolone acetonide implant therapy. BCVA was measured by masked examiners at baseline and 2 years’ follow-up using gold standard methods. Data regarding characteristics possibly predictive of changes in visual acuity were derived via the standard study protocol administered across the 23 clinical centers.
Among 479 uveitic eyes (of 255 patients) enrolled, 431 had baseline and two year BCVA data, two of which were excluded because of no light perception at baseline. By two years, eyes better than 20/50 and 20/50 or worse at baseline improved a mean of 0.2 lines (p=0.52) and 2.0 lines (p<0.001) respectively. The implant and systemic groups improved to a similar degree. Anterior/intermediate uveitis (mean=1.2 lines, p=0.11), intermediate uveitis (mean=0.6 lines, p=0.12), posterior uveitis (mean=1.0 lines, p=0.03), and panuveitis cases (mean=1.0 lines, p=0.003) all improved on average (p(difference amongst the groups)=0.84). Factors predictive of improved BCVA included resolution of active anterior chamber cells (mean=2.6 lines, p<0.001) and flare (mean=1.4 lines, p=0.06), and resolution of vitreous haze (mean=1.4 lines, p=0.05), posterior synechiae (reflecting interval cataract surgery, mean=2.6, p=0.001), and macular thickening (mean=2.4 lines, p<0.001).
While receiving standardized systemic or fluocinolone acetonide implant therapy, the average anterior/intermediate, intermediate, posterior, or panuveitis case presenting with poor BCVA improved, while the average case presenting with normal BCVA retained normal BCVA. Control of anterior chamber and vitreous inflammation, cataract surgery (when indicated) and resolution of macular edema were associated with improvement over a two year interval.
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